[Analysis and precise intervention on pathogenic genes and mechanisms of lupus nephritis]

Lupus nephritis is the most common complication of systemic lupus erythematosus (SLE) and an important cause of end-stage kidney disease and death in patients with SLE. The pathogenesis of SLE is complex, with no effective treatment and poor long-term prognosis. The development of genomic medicine provides a new way to explore the disease-causing genes and pathogenesis of lupus nephritis. Here, the article introduces how to uncover the pathogenesis of lupus nephritis from the genome level and explore new strategies for diagnosis and treatment on this disease.

SIRT3 regulates cardiolipin biosynthesis in pressure overload-induced cardiac remodeling by PPARγ-mediated mechanism

Cardiac remodeling is the primary pathological feature of chronic heart failure (HF). Exploring the characteristics of cardiac remodeling in the very early stages of HF and identifying targets for intervention are essential for discovering novel mechanisms and therapeutic strategies. Silent mating type information regulation 2 homolog 3 (SIRT3), as a major mitochondrial nicotinamide adenine dinucleotide (NAD)-dependent deacetylase, is required for mitochondrial metabolism. However, whether SIRT3 plays a role in cardiac remodeling by regulating the biosynthesis of mitochondrial cardiolipin (CL) is unknown. In this study, we induced pressure overload in wild-type (WT) and SIRT3 knockout (SIRT3-/-) mice via transverse aortic constriction (TAC). Compared with WT mouse hearts, the hearts of SIRT3-/- mice exhibited more-pronounced cardiac remodeling and fibrosis, greater reactive oxygen species (ROS) production, decreased mitochondrial-membrane potential (ΔΨm), and abnormal mitochondrial morphology after TAC. Furthermore, SIRT3 deletion aggravated TAC-induced decrease in total CL content, which might be associated with the downregulation of the CL synthesis related enzymes cardiolipin synthase 1 (CRLS1) and phospholipid-lysophospholipid transacylase (TAFAZZIN). In our in vitro experiments, SIRT3 overexpression prevented angiotensin II (AngII)- induced aberrant mitochondrial function, CL biosynthesis disorder, and peroxisome proliferator-activated receptor gamma (PPARγ) downregulation in cardiomyocytes; meanwhile, SIRT3 knockdown exacerbated these effects. Moreover, the addition of GW9662, a PPARγ antagonist, partially counteracted the beneficial effects of SIRT3 overexpression. In conclusion, SIRT3 regulated PPARγ-mediated CL biosynthesis, maintained the structure and function of mitochondria, and thereby protected the myocardium against cardiac remodeling.

[Respiratory virus infection and its influence on outcome in children with septic shock]

Objective: To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes. Methods: The clinical data of children with septic shock in children's PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results: A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs (OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions: The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.

Translation, cultural adaptation, and validation of the Chinese standardized outcomes in nephrology-hemodialysis fatigue (C-SONG-HD fatigue) scale: a study of Chinese patients undergoing hemodialysis

OBJECTIVE

This study aimed to translate and culturally adapt the standardized outcomes in nephrology-hemodialysis fatigue (SONG-HD fatigue) scale and to assess the psychometric properties of the Chinese version of the SONG-HD fatigue (C-SONG-HD fatigue) scale.

METHODS

Forward and back translations were used to translate the SONG-HD fatigue scale into Chinese. We used the C-SONG-HD fatigue scale to survey Chinese patients undergoing hemodialysis (HD) in China. We examined the distribution of responses and floor and ceiling effects. Cronbach's alpha and McDonald's omega coefficient, intraclass coefficients, and Spearman correlations were used to assess internal consistency reliability, test-retest reliability, and convergent validity, respectively. Responsiveness was also evaluated.

RESULTS

In total, 489 participants across southeast China, northwest China, and central China completed the study. The C-SONG-HD fatigue scale had good internal consistency (Cronbach's alpha coefficient 0.861, omega coefficient 0.916), test-retest reliability (intraclass correlation coefficient 0.695), and convergent validity (Spearman correlation 0.691). The analysis of all first-time HD patients did not show notable responsiveness, and only patients with temporary vascular access had good responsiveness with an effect size (ES) of 0.54, a standardized response mean (SRM) of 0.85, and a standard error of measurement (SEM) of 0.77.

CONCLUSION

The Chinese version of the SONG-HD fatigue scale showed satisfactory reliability and validity in patients undergoing hemodialysis (HD) in China. It could be used as a tool to measure the fatigue of Chinese HD patients.

[Carbon Reduction Analysis of Life Cycle Prediction Assessment of Hydrogen Fuel Cell Vehicles：Considering Regional Features and Vehicle Type Differences]

As one of the important paths for China to achieve the "dual carbon" strategy， developing hydrogen fuel cell vehicles is currently being promoted in various regions across the country， including passenger cars， coaches， and heavy-duty trucks. Quantifying the carbon reduction potential of hydrogen fuel cell vehicles for different vehicle types and regions has become a hot research topic. Using a life cycle assessment method that considers future vehicle fuel economy， power generation carbon emission factors， hydrogen production carbon emission factors， and regional differences in the scale and hydrogen production methods， this study quantitatively evaluated the life cycle carbon emissions of different types of vehicles， including fuel cell vehicles （FCV）， traditional fuel vehicles （ICEV）， and battery electric vehicles （BEV）. We compared and analyzed the carbon reduction potential of hydrogen fuel cell vehicles at different times and in different regions and conducted an uncertainty analysis on hydrogen consumption per hundred kilometers. The results showed that by 2025， the life cycle carbon emissions of hydrogen fuel cell coaches would decrease by 36.0% compared to that of traditional fuel coaches， but the reduction in carbon emissions for hydrogen fuel cell heavy-duty trucks was not significant. By 2035， as the hydrogen energy source structure in China continues to improve， the life cycle carbon emissions of hydrogen fuel cell heavy-duty trucks were predicted to decrease by 36.5% compared to that of traditional fuel heavy-duty trucks. The decarbonization potential was most significant for heavy-duty trucks compared to that of passenger cars and coaches. Taking the Beijing-Tianjin-Hebei demonstration group as an example in 2035， as the hydrogen consumption per hundred kilometers decreases by 20%， the carbon reduction potential of FCV passenger cars， coaches， and heavy-duty trucks would increase by 7.29%， 9.93%， and 19.57%， respectively. Therefore， it is recommended to prioritize the promotion of hydrogen fuel cell coaches in the short term， heavy-duty trucks in the long term， and passenger cars as a supplement. Promoting hydrogen fuel cell vehicles in different regions and stages will help advance the low-carbon development of the automotive industry in China.

Efficient Integration of Rate-Adaptive Reconciliation with Syndrome-Based Error Estimation and Subblock Confirmation for Quantum Key Distribution

An effective post-processing algorithm is essential for achieving high rates of secret key generation in quantum key distribution. This work introduces an approach to quantum key distribution post-processing by integrating the three main steps into a unified procedure: syndrome-based error estimation, rate-adaptive reconciliation, and subblock confirmation. The proposed scheme employs low-density parity-check codes to estimate the quantum bit error rate using the syndrome information, and to optimize the channel coding rates based on the Slepian-Wolf coding scheme for the rate-adaptive method. Additionally, this scheme incorporates polynomial-based hash verification in the subblock confirmation process. The numerical results show that the syndrome-based estimation significantly enhances the accuracy and consistency of the estimated quantum bit error rate, enabling effective code rate optimization for rate-adaptive reconciliation. The unified approach, which integrates rate-adaptive reconciliation with syndrome-based estimation and subblock confirmation, exhibits superior efficiency, minimizes practical information leakage, reduces communication rounds, and guarantees convergence to the identical key. Furthermore, the simulations indicate that the secret key throughput of this approach achieves the theoretical limit in the context of a BB84 quantum key distribution system.

Exopolysaccharides from endophytic Glutamicibacter halophytocota KLBMP 5180 functions as bio-stimulants to improve tomato plants growth and salt stress tolerance

Microbial exopolysaccharides (EPSs) can promote plants growth and protect them against various abiotic stresses, but the role of actinobacteria-produced EPSs in plant growth promoting is still less known. Here, we aim to explore the effect of EPSs from an endophyte Glutamicibacter halophytocota KLBMP 5180 on tomato seeds germination and seedlings growth under salt stress. Our study revealed that 2.0 g/L EPSs resulted in increased seed germination rate by 23.5 % and 11.0 %, respectively, under 0 and 200 mM NaCl stress conditions. Further pot experiment demonstrated that EPSs significantly promoted seedlings growth under salt stress, with increased height, root length and fibrous roots number. Plant physiological traits revealed that EPSs increased chlorophyll content, enhanced the activity of antioxidant enzymes, soluble sugar, and K+ concentration in seedlings; malondialdehyde and Na+ contents were reduced. Additionally, auxin, abscisic acid, jasmonic acid, and salicylic acid were accumulated significantly in seedlings after EPSs treatment. Furthermore, we identified 1233 differentially expressed genes, and they were significantly enriched in phytohormone signal transmission, phenylpropanoid biosynthesis, and protein processing in endogenous reticulum pathways, etc. Our results suggest that KLBMP 5180-produced EPSs effectively ameliorated NaCl stress in tomato plants by triggering complex regulation mechanism, and showed application potentiality in agriculture.

Achieving High Core Neuron Density in a Neuromorphic Chip Through Trade-off Among Area, Power Consumption, and Data Access Bandwidth

As a crucial component of neuromorphic chips, on-chip memory usually occupies most of the on-chip resources and limits the improvement of neuron density. The alternative of using off-chip memory may result in additional power consumption or even a bottleneck for off-chip data access. This article proposes an on- and off-chip co-design approach and a figure of merit (FOM) to achieve a trade-off between chip area, power consumption, and data access bandwidth. By evaluating the FOM of each design scheme, the scheme with the highest FOM (1.085× better than the baseline) is adopted to design a neuromorphic chip. Deep multiplexing and weight-sharing technologies are used to reduce on-chip resource overhead and data access pressure. A hybrid memory design method is proposed to optimize on- and off-chip memory distribution, which reduces on-chip storage pressure and total power consumption by 92.88% and 27.86%, respectively, while avoiding the explosion of off-chip access bandwidth. The co-designed neuromorphic chip with ten cores fabricated under standard 55 nm CMOS technology has an area of 4.4 mm 2 and a core neuron density of 4.92 K/mm 2, an improvement of 3.39  ∼ 30.56× compared with previous works. After deploying a full-connected and a convolution-based spiking neural network (SNN) for ECG signal recognition, the neuromorphic chip achieves 92% and 95% accuracy, respectively. This work provides a new path for developing high-density and large-scale neuromorphic chips.

Real-world tobacco cessation practice in China: findings from the prospective, nationwide multicenter China National Tobacco Cessation Cohort Study (CNTCCS)

Background

Tobacco cessation is proven to be the most effective and cost-effective strategy for smokers to reduce their risk of smoking-related disease and premature death. Providing effective, efficient, safe, and patient-centred tobacco cessation treatment to reach those who need them is a significant challenge. To date, only a few nationwide studies in China have assessed the overall clinical care practice and treatment outcome of tobacco cessation.

Methods

This a prospective, nationwide, multicenter, cohort study covering all Eastern China, Northwest China, Central China, North China, Southwest China, Northeast China, and South China. Participants who were current smokers aged 18-85 years attending clinic for smoking cessation were included. All the participants were treated with 3-month cessation treatment and followed up for 3 months. Data were collected prospectively using online system. The primary outcome was 7-day point abstinence rate at 24 weeks, validated biochemically by an expired carbon monoxide level of less than 10 ppm. The participants lost to follow-up or not providing validation were included as non-abstainers.

Findings

A representative sample of 3557 participants were recruited and 2943 participants were included into this analysis. These participants had mean age of 53.05 years, and 94.8% were males, with 75.8% showing symptoms of tobacco dependence. A total of 965 (32.8%) participants were treated with Bupropion + behavioural counselling, followed by 935 (31.8%) with behavioural counselling, 778 (26.4%) with Varenicline + behavioural counselling, 135 (4.6%) with alternative treatments + behavioural counselling, and 130 (4.4%) with nicotine replacement therapy (NRT) + behavioural counselling. After 3-month treatment and 3-month follow-up, 21.74% of the participants quit smoking at 24 weeks. In the multivariable-adjusted analyses, quitting smoking was significantly associated with female, higher socioeconomic status, poor health condition, different treatment received, and less smoking intensity. The tobacco cessation treatment varied widely across different areas of China. In particular, the areas with higher usage of cessation medication were associated with better cessation treatment outcome.

Interpretation

The CNTCCS is the first large-scale nationwide cohort study of smoking cessation in China. Rich data collected from this prospective cohort study provided the opportunity to evaluate the clinical practice of tobacco cessation treatment in China.

Funding

Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (CAMS 2021-I2M-1-010), Heilongjiang Provincial Science and Technology Key Program (2022ZXJ03C02), and National Key R&D Program of China (grant no. 2017YFC1309400).

[Meta-analysis of Ac-SDKP inhibition of Pulmonary fibrosis in animal models]

Objective: To systematically study the anti-fibrotic effect of N-acetyl-seryl-as partyl-lysyl-proline (Ac-SDKP) on pulmonary fibrosis. Methods: In May 2021, a computer search was performed on CNKI, Wanfang Knowledge Service Platform, VIP.com, China Biomedical Literature Database, Pubmed, OVID and other databases. The retrieval time was from January 2008 to May 2021. Randomized controlled experiments on the inhibition of pulmonary fibrosis by Ac-SDKP were screened. The control group was the pulmonary fibrosis model group and the experimental group was the Ac-SDKP treatment group. The quality of the literature was assessed using the syrcle risk of bias assessment tool, and data were extracted. Data analysis was Performed using revman 5.4 software. Results: 18 papers were included, with a total of 428 animal models. The results of meta analysis showed that the contents of α-smooth muscle actin (α-SMA), type I collagen, type Ⅲ collagen, transforming growth factor-β (TGF-β) and Nodule area in the exPerimental group were lower than those in the control grouP. [SMD=-2.44, 95%CI (-3.71--1.17), P=0.000][SMD=-5.36, 95%CI (-7.13--3.59), P=0.000] [SMD=-3.07, 95%CI (-4.13--2.02), P<0.000][SMD=-2.88, 95%CI (-3.63--2.14), P=0.000] [SMD=-1.80, 95%CI (-2.42--1.18), P=0.000], the content of hydroxy proline in the experimental group was higher than that in the control group [SMD=7.62, 95%CI (4.90-10.33), P=0.000], all indexes included in the literature were statistically significant. Conclusion: Ac-SDKP has obvious inhibitory effect on the process of pulmonary fibrosis, and may become a new clinical drug for the treatment of pulmonary fibrosis.

[Life Cycle Prediction Assessment of Energy Saving and New Energy Vehicles for 2035]

The development of energy saving and new energy vehicles is an important technology path to reduce carbon emissions for the transportation industry. To quantitatively predict the life cycle carbon emissions of energy saving and new energy vehicles, this study used the life cycle assessment method and selected the fuel economy level, lightweight level, carbon emission factor of electricity structure, and carbon emission factor of hydrogen production as key performance parameters to establish inventories of internal combustion engine vehicles (ICEV), mild hybrid electrical vehicles (MHEV), heavy hybrid electrical vehicles (HEV), battery electrical vehicles (BEV), and fuel cell vehicles (FCV) based on automotive-related policy and technical routes. The sensitivity of carbon emission factors of electricity structure and different hydrogen production methods were analyzed and discussed. The results showed that the current life cycle carbon emissions (CO₂ equivalent) of ICEV, MHEV, HEV, BEV, and FCV were 207.8, 195.2, 149.9, 113.3, and 204.7 g·km^-1, respectively. By 2035, BEV and FCV were predicted to have a significant reduction of 69.1% and 49.3%, respectively, compared with ICEV. The carbon emission factor of electricity structure had the most significant influence on BEV life cycle carbon emissions. In terms of different hydrogen production methods of FCV, hydrogen demand should be mainly supplied by industrial hydrogen by-product purification in the short-term future, whereas hydrogen energy production by water electrolysis and hydrogen production from fossil energy combined with carbon capture, utilization, and storage technology should be used to meet the hydrogen demand of FCV in the long-term future, so as to achieve a significant improvement in the life cycle carbon reduction benefits of FCV.

Reference-frame-independent quantum key distribution with advantage distillation

Advantage distillation (AD) provides a means of separating highly correlated raw key bits from weakly correlated information in quantum key distribution (QKD). In this Letter, we apply the AD method to improve the performance of reference-frame-independent QKD (RFI-QKD). Simulation results show that, compared with RFI-QKD without AD, RFI-QKD with AD can tolerate higher system errors and obtain better performance on the secret key rate and transmission distance. Furthermore, we extend the AD method to RFI measurement-device-independent QKD (RFI-MDI-QKD) and demonstrate that the AD method can improve the performance of RFI-MDI-QKD more significantly.

Improved reference-frame-independent quantum key distribution: erratum

We present an erratum to our Letter [Opt. Lett.47, 4219 (2022)10.1364/OL.470558]. This erratum corrects the error results of Figs. 2 and 4 due to the error in the simulation code. The corrections have no influence on the conclusions of the original Letter.

A Co-Designed Neuromorphic Chip With Compact (17.9K F2) and Weak Neuron Number-Dependent Neuron/Synapse Modules

Many efforts have been made to improve the neuron integration efficiency on neuromorphic chips, such as using emerging memory devices and shrinking CMOS technology nodes. However, in the fully connected (FC) neuromorphic core, increasing the number of neurons will lead to a square increase in synapse & dendrite costs and a high-slope linear increase in soma costs, resulting in an explosive growth of core hardware costs. We propose a co-designed neuromorphic core (SRCcore) based on the quantized spiking neural network (SNN) technology and compact chip design methodology. The cost of the neuron/synapse module in SRCcore weakly depends on the neuron number, which effectively relieves the growth pressure of the core area caused by increasing the neuron number. In the proposed BICS chip based on SRCcore, although the neuron/synapse module implements 1∼16 times of neurons and 1∼66 times of synapses, it only costs an area of 1.79 × 10⁷ F², which is 7.9%∼38.6% of that in previous works. Based on the weight quantization strategy matched with SRCcore, quantized SNNs achieve 0.05%∼2.19% higher accuracy than previous works, thus supporting the design and application of SRCcore. Finally, a cross-modeling application is demonstrated based on the chip. We hope this work will accelerate the development of cortical-scale neuromorphic systems.

[Analysis of clinical features and surgical outcomes of petrous bone cholesteatomas]

Objective: To analyze the clinical features and surgical outcomes of petrous bone cholesteatomas (PBCs). Methods: Data from 39 PBCs patients treated in the Department of Otorhinolaryngology, Xijing Hospital from September 2011 to December 2017 were reviewed retrospectively, including 23 males, 16 femals, aged 12-71 years old, with the median age of 37. Clinical classifications, surgical methods, facial and hearing function, and intraoperative and postoperative complications were made summary analysis. Results: In this study, five patients were congenital PBCs and 34 patients were acquired PBCs. The common clinical symptoms were hearing loss (100%, 39/39), ear discharge/pus (89.7%, 35/39) and facial paralysis (46.2%, 18/39). According to Sanna's classification, 14 cases were supralabyrinthine, including three cases underwent transcochlear (TC) approach, six cases underwent transotic (TO) approach and five underwent translabyrinthine (TL) approach. 10 cases were infralabyrinthine, including eight cases underwent subtotal petrosectomy, one case underwent TO approach and one underwent TL approach.10 cases were massive, including seven cases underwent TC approach, three cases underwent TO approach. Five cases were infralabyrinthine-apical, including two cases underwent TC approach, two cases underwent TO approach, and one case underwent endoscope assisted infratemporal fossa type B. The degree of facial nerve (FN) dysfunction from high to low was massive (6/10), supralabyrinthine (8/14), infralabyrinthine-apical (2/5) and infralabyrinthine (2/10). 19 cases involved in facial nerve operation, three cases underwent FN decompression, four cases underwent FN rerouting, four cases underwent nerve grafting, and one case underwent facial-hypoglossal anastomosis. Preoperative FN involvement in 18 cases, and the FN function was improved in 14 cases after surgery. The improved rate of postoperative FN function was 77.8%. The bone conducted hearing retained 50.0% (14/28) postoperatively. Five cases with cerebrospinal fluid leak were managed by inserting free muscle plugs and cavity obliteration. Two cases with the cholesteatomas matrix involved the sigmoid sinus and the jugular bulb, and occlusion of the sigmoid sinus was performed. Postoperatively, two patients presented with synkinesis. The patients were followed up for 40 to 115 months, and there was no recurrence. Conclusions: There are no specific clinical manifestations for PBCs, thus, it is difficult in early diagnosis and treatment. According to Sanna's classification, preoperative FN and hearing function, the best surgical approach should be selected with minimal recurrences and perioperative morbidity.

The Reproductive Outcome of Women with Hypogonadotropic Hypogonadism in IVF

OBJECTIVE

The purpose of this study was to evaluate the reproductive outcome of patients with hypogonadotropic hypogonadism (HH) receiving in vitro fertilization and embryo transfer (IVF-ET).

METHODS

The reproductive outcome of 81 HH patients and 112 controls who underwent oocyte retrieval was evaluated retrospectively in the Center for Reproductive Medicine of Peking University Third Hospital from 2010 to 2019.

RESULTS

The basic levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), androstenedione (A) and prolactin (PRL) were significantly lower in the HH group than the control group. Although the HH patients required a significantly longer stimulation and higher gonadotropin (Gn) doses than the control patients, the total number of oocytes retrieved, fertilized embryos, two pronuclear (2PN) embryos, transferable embryos, fertilization and 2PN rates were comparable between the two groups. Although the live birth rate (LBR) of the first fresh cycle was higher in the control group than the HH group, there was no statistical significance. Then we further divided HH patients into two subgroups according to the etiology. Forty-one cases were termed as congenital HH (CHH), while the other 40 cases were termed as acquired HH (AHH), the latter includes functional hypothalamic amenorrhea (FHA) and pituitary HH (PHH). Our results showed that there were no significant differences in basic clinical characteristics and IVF parameters between the two groups. In the HH group, a total of 119 oocyte retrieval cycles were carried out and they responded adequately to ovulation induction. Urinary human menopausal gonadotropin (HMG) was used alone in 90 cycles while combination of HMG and recombinant human follicle stimulating hormone (rFSH) in the other 29 cycles. There were no significant differences in IVF-related parameters between the two groups. The conservative cumulative live birth rates (CLBRs) after the first, the second and ≥third cycles were 43.21%, 58.02% and 60.49%, respectively, while the corresponding optimal CLBRs were 43.21%, 68.45% and 74.19%. The preterm birth (PTB) rates of singletons and twin pregnancy in HH patients were 8.33% (3/36) and 30.77% (4/13), respectively.

CONCLUSION

IVF-ET is an effective treatment for HH patients with infertility and patients can get satisfactory pregnancy outcomes.

Improved analysis of measurement-device-independent quantum key distribution with non-phase-randomized coherent states

Measurement-device-independent quantum key distribution (MDI-QKD) can remove all detector side-channel attacks, which can be implemented with phase-randomized coherent states (PRCS) or non-phase-randomized coherent states (NPRCS). In this paper, we focus on the MDI-QKD protocol with NPRCS and provide an improved analysis. In contrast with the original MDI-QKD with NPRCS which modulates the same intensity of coherent states in the key and test bases, we propose to modulate different intensities of coherent states in the key and test bases. Simulation results show that the secret key rate and transmission distance of MDI-QKD with NPRCS can be significantly improved. Furthermore, it is noteworthy that the modulation of different intensities does not bring extra complexity for experimental researchers, which can be easily done by adding an intensity modulator.

Twin-field quantum digital signatures

Digital signature is a key technique in information security, especially for identity authentications. Compared to classical correspondence, quantum digital signatures (QDSs) provide a considerably higher level of security. At present, its performance is limited by key generation protocols, which are fundamentally limited in terms of channel capacity. Based on the idea of twin-field quantum key distribution, this Letter presents a twin-field QDS protocol and details a corresponding security analysis. In its distribution stage, a specific key generation protocol, the sending-or-not-sending twin-field protocol, has been adopted. Besides, we present a systematic model to evaluate the performance of a QDS protocol and compare the performance of our protocol to other typical QDS protocols. Numerical simulation results show that the new protocol exhibits outstanding security and practicality compared to other existing protocols. Therefore, our protocol paves the way toward real-world applications of QDSs.

Biodegradation of phenol by a halotolerant versatile yeast Candida tropicalis SDP-1 in wastewater and soil under high salinity conditions

In this study, a novel halotolerant phenol-degrading yeast strain, SDP-1, was isolated from a coastal soil in Jiangsu, China, and identified as Candida tropicalis by morphology and rRNA internal transcribed space region sequence analysis. Strain SDP-1 can efficiently remove phenol at wide ranges of pH (3.0-9.0), temperature (20-40 °C), and NaCl (0-5%, w/v), as well as the tolerance of Mn²⁺, Zn²⁺ and Cr³⁺ in aquatic phase. It also utilized multiple phenol derivatives and aromatic hydrocarbons as sole carbon source and energy for growth. Free cells of SDP-1 were able to degrade the maximum phenol concentration of 1800 mg/L within 56 h under the optimum culture conditions of 10% inoculum volume, pH 8.0, 35 °C and 200 rpm agitation speed. Meanwhile, SDP-1 was immobilized on sodium alginate, and the capability of efficiently phenol degradation of free cells and immobilized SDP-1 were evaluated. Shortened degradation time and long-term utilization and recycling for immobilized SDP-1 was achieved compared to free cells. The 1200 mg/L of phenol under 5% NaCl stress could be completely degraded within 40 h by immobilized cells. In actual industrial coking wastewater, immobilized cells were able to completely remove 383 mg/L phenol within 20 h, and the corresponding chemical oxygen demand (COD) value was decreased by 50.38%. Besides, in phenol-contained salinity soil (3% NaCl), 100% of phenol (500 and 1000 mg/kg) removal efficiency was achieved by immobilized SDP-1 within 12 and 26 days, respectively. Our study suggested that versatile yeast Candida tropicalis SDP-1 could be potentially used for enhanced treatment of phenol-contaminated wastewater and soil under hypersaline or no-salt environmental conditions.

Complete Genome Sequence of the Biocontrol Agent Pseudomonas chlororaphis subsp. aureofaciens SPS-41

Pseudomonas chlororaphis subsp. aureofaciens SPS-41 is a plant growth-promoting rhizobacterium with biocontrol potential that was isolated from the rhizosphere of sweet potato in Xuzhou, Jiangsu Province, China. Our previous study demonstrated that volatile organic compounds (VOCs) produced by SPS-41 inhibited black spot disease fungi Ceratocystis fimbriata in postharvest sweet potatoes and a variety of other plant pathogens, and the VOCs also displayed strong nematocidal activity. In order to further explore the application potential of this strain, we here report the complete genome sequence of strain SPS-41. The genome consists of one chromosome (6,757,898 bp) with a G+C content 63.10%, which contains 5,951 coding genes, 67 transfer RNA genes, 16 ribosome RNA genes, and 85 other non-coding RNA genes. No plasmid was detected. The information of the genome will provide resources for studying the biocontrol mechanism of this strain.[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

[Long-term efficacy of radiofrequency closure in the treatment of great saphenous vein varicose]

Objective: To examine the long-term efficacy of radiofrequency closure in the treatment of great saphenous vein varicose. Methods: The clinic data of 185 patients with varicose veins of lower limbs treated with radiofrequency closure admitted at Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University from July 2016 to January 2017 was analyzed retrospectively. A total of 203 limbs were treated by radiofrequency closure. The long-term efficacy of radiofrequency closure was evaluated by analyzing the closure rate, clinical-etiology- anatomy-pathophysiology (CEAP) grading, venous clinical severity score (VCSS), chronic venous insufficiency questionnaire (CIVIQ) score, and complications, using repeated measures analysis of variance. Results: All procedures were successful. The closure rate was 98.0% (199/203) at one year and two years postoperative, which was still maintained at 97.5% (198/203) at 3 years of follow-up. Postoperative CEAP grading was significantly downgraded compared with that before the operation. Totally 88.4% (76/86) of C5 to C6 grade patients downgraded to C2 to C4 grade at 6 months, and 95.3% (82/86) downgraded to C0 to C2 garde at 3 years postoperative. VCSS and CIVIQ score in both groups significantly improved at all follow-up time points compared to preoperative scores (VCSS: F=1 064.7, P=0.003; CIVIQ score: F=2 984.3, P=0.001). The most common complication was subcutaneous blood stasis (10.8%), most of which disappeared within 1 month after the surgery. Other complications included pigmentation and thrombophlebitis (5.9% and 3.9%, respectively). Conclusion: The long-term efficacy of radiofrequency closure of the great saphenous vein is satisfactory.

Phosphatidylserine-exposing tumor-derived microparticles exacerbate coagulation and cancer cell transendothelial migration in triple-negative breast cancer

Background: Neoadjuvant chemotherapy is relevant to the formation of thromboembolism and secondary neoplasms in triple-negative breast cancer (TNBC). Chemotherapy-induced breast cancer cell-derived microparticles (BCMPs) may have important thrombogenic and pro-metastatic effects on platelets and endothelium, which may be related to the expression and distribution of phosphatidylserine (PS). However, investigating these interactions is challenging due to technical limitations.

Methods: A study was conducted in 20 healthy individuals and 18 patients who had been recently diagnosed with TNBC and were undergoing neoadjuvant chemotherapy with doxorubicin and cyclophosphamide. BCMPs were isolated from patient blood samples and doxorubicin-treated breast cancer cell lines. Their structure and morphology were studied by electron microscopy and antigen levels were measured by fluorescence-activated cell sorting. In an inhibition assay, isolated BCMPs were pretreated with lactadherin or tissue factor antibodies. Platelets isolated from healthy subjects were treated with BCMPs and coagulation time, fibrin formation, and expression of intrinsic/extrinsic factor Xase (FXa) and thrombin were evaluated. The effects of BCMPs on endothelial thrombogenicity and integrity were assessed by confocal microscopy, electron microscopy, measurement of intrinsic/extrinsic FXa, prothrombinase assay, and transwell permeability assay.

Results: Neoadjuvant chemotherapy significantly increased the expression of PS+ BCMPs in patient plasma. Its expression was associated with a rapid increase in procoagulant activity. Treatment with lactadherin, a PS-binding scavenging molecule, markedly reduced the adhesion of BCMPs and abolished their procoagulant activity, but this was not observed with tissue factor antibody treatment. Intravenous injection of BCMPs in mice induced a significant hypercoagulable state, reducing the extent of plasma fibrinogen and promoting the appearance of new thrombus. Cancer cells incubated with doxorubicin released large numbers of PS+ BCMPs, which stimulated and transformed endothelial cells into a procoagulant phenotype and increased the aggregation and activation of platelets. Moreover, cancer cells exploited this BCMP-induced endothelial leakiness and showed promoted metastasis. Pretreatment with lactadherin increased uptake of both PS+ BCMPs and cancer cells by endothelial cells and limited the transendothelial migration of cancer cells.

Conclusion: Lactadherin, a biosensor that we developed, was used to study the extracellular vesicle distribution of PS, which revealed a novel PS+ BCMPs administrative axis that initiated a local coagulation cascade and facilitated metastatic colonization of circulating cancer cells.

The efficacy and safety of gemcitabine-based induction chemotherapy for locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiation: A meta-analysis

OBJECTIVES

To assess the efficacy and toxicity of gemcitabine-based induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) in locally advanced nasopharyngeal carcinoma (LA-NPC).

METHODS

Both observational studies (OBS) and randomized controlled trials (RCT) were included in the meta-analysis. Systematic online searches were conducted in Web of Sciences, PubMed, Embase, meeting proceedings and ClinicalTrials.gov from the inception to May 25, 2020. The primary endpoint of interest was overall survival.

RESULTS

five OBSs and 2 RCTs including 1680 patients were incorporated in the analysis. The evidence from the RCTs showed that adding gemcitabine-based induction chemotherapy to CCRT significantly improved progression free survival (hazard ratio (HR): 0.60, 95% confidence interval (CI): 0.40-0.88; P = .010; chi square P = .25; I2 = 24%) and overall survival (HR: 0.47; 95% CI: 0.28-0.80; P = 0.005; chi square P = .49, I2 = 0%) and was related to a higher risk of hematological toxicities. Furthermore, based on the data of OBSs, overall survival (HR: 0.52; 95% CI: 0.31-0.88; P = .02; chi square P = .37, I2 = 6%) was significantly improved in patients treated with gemcitabine-based induction chemotherapy compared to those treated with taxane-based induction chemotherapy. However, the progression free survival (HR: 0.67; 95% CI: 0.45-1.01; P = .06; chi square P = .74; I2 = 0%) showed no significant difference.

CONCLUSIONS

For LA-NPC patients, adding gemcitabine-based induction chemotherapy to CCRT significantly improved overall survival and progression free survival with a higher risk of hematological toxicities when compared to CCRT alone. Also, gemcitabine-based regimen could be used as an alternative induction chemotherapy regimen to taxane-based regimen in the treatment of LA-NPC.

Chinese version of the clinical supervision self-assessment tool: Assessment of reliability and validity

BACKGROUND

Cultivating the professional knowledge and professional identity of nursing students is important for nursing education. The degree of professional identity of nursing students will directly affect their career options and work performance after graduation. Clinical practice is a learning process of combining the knowledge and the practical techniques of nursing. It is the important way to cultivate the students' comprehensive ability, professional attitude and professional emotion. Effective clinical supervision during the clinical practice plays an important role in guaranteeing clinial practice quality and cultivating professional nursing students. Active teaching supervision is helpful to achieve the expected learning effect. Therefore, it is vital to evaluate the clinical supervision ability of the clinical nursing teachers. However, there is no special assessment instrument available in China.

OBJECTIVES

To assess the validity and reliability of the Chinese version of the modified Clinical Supervision Self-Assessment Tool (mCAST).

DESIGN

A cross sectional survey design with a convenience sample was used in this study. This cross-sectional psychometric instrumental study determined the reliability and validity of the Chinese version of the modified Clinical Supervision Self-Assessment Tool (mCAST).

SETTINGS

Twelve hospitals in Tianjin, China.

PARTICIPANTS

A total of 350 registered nurses who perform teaching tasks in clinical practice were recruited.

METHODS

The Chinese version of the mCSAT was translated and tested by obtaining the authorization of the developer of the mCAST using Brislin's model (that is, translation, back translation, cultural adaptation and pilot study). A total of 350 registered nurses who perform teaching tasks in clinical practice were recruited by convenience sampling for the assessment of construct validity using exploratory factor analysis (EFA). Moreover, item analysis, internal correlation coefficients, Cronbach's alpha coefficients, test-retest realibility and split-half reliability were conducted to test the psychometric properties of the Chinese version of the mCSAT.

RESULTS

The Chinese version of the mCSAT contained 2 subscales, namely, mCSAT-Knowledge and mCSAT-Skills. Exploratory factor analysis of the knowledge and skills subscales explained 63.26% and 63.60% of the total variances, respectively. The mCSAT-Knowledge subscale contains 3 dimensions, namely, evaluating learning (10 items), facilitating learning (9 items) and problem solving (10 items); the mCSAT-Skills subscale contains 3 dimensions, namely, evaluating learning (10 items), facilitating learning (9 items) and problem solving (10 items). The Cronbach's α coefficients of the mCSAT-Knowledge and mCSAT-Skills subscales were both 0.95. The split-half reliability of the mCSAT-Knowledge and mCSAT-Skills subscales were 0.88 and 0.89, respectively.

CONCLUSION

The Chinese version of the mCSAT was reliable and valid in the evaluation of the knowledge and skills for the clinical supervision of registered nurses. Further validation of the Chinese version of the mCSAT requires a more representative and larger sample. Also, the confirmatory factor analysis should be conducted in future study.

Experimental three-state measurement-device-independent quantum key distribution with uncharacterized sources

Measurement-device-independent quantum key distribution (MDI-QKD) removes all detector side-channel attacks and guarantees a promising way for remote secret keys sharing. Several proof-of-principal experiments have been demonstrated to show its security and practicality. However, these practical implementations demand mostly, for example, perfect state preparation or completely characterized sources to ensure security, which are difficult to realize with prior art. Here, we investigate a three-state MDI-QKD using uncharacterized sources, with the simple requirement that the encoding state is bidimensional, which eliminates security threats from both the source flaws and detection loopholes. As a demonstration, a proof-of-principal experiment over 170 km transmission distance based on Faraday-Michelson interferometers is achieved, representing, to the best of our knowledge, the longest transmission distance recorded under the same security level.

Root exudates-driven rhizosphere recruitment of the plant growth-promoting rhizobacterium Bacillus flexus KLBMP 4941 and its growth-promoting effect on the coastal halophyte Limonium sinense under salt stress

Halophytes play an important role in the bioremediation of saline soils. Increased evidence has revealed that plant growth-promoting rhizobacteria (PGPR) have colonized the halophytic rhizosphere, and they have evolved the capacity to reduce salt stress damage to the host. However, the mechanism by which halophytes attract and recruit beneficial PGPR has rarely been reported. This study reports the interaction between the halophyte Limonium sinense and its rhizosphere PGPR strain Bacillus flexus KLBMP 4941, as well as the mechanism by which KLBMP 4941 promotes host plant growth under salt stress. After salt stress treatment, we collected the root exudates (REs) of L. sinense and found that the REs could promote the growth and chemotaxis of the bacterium KLBMP 4941. In addition, the components of the REs under salt stress were analyzed, and some organic acids (2-methylbutyric acid, stearic acid, palmitic acid, palmitoleic acid, and oleic acid) were detected as the major components. Further assessment showed that each of these components had positive effects on the growth, motility, chemotaxis, and root colonization of strain KLBMP 4941. Further pot experiments revealed the potential PGP mechanisms induced by strain KLBMP 4941 on the host plant under salt stress. Inoculation with KLBMP 4941 promoted the accumulation of chlorophyll to enhance photosynthesis, increased osmotic regulator contents, enhanced flavonoid and antioxidant enzymes, and regulated Na⁺/K⁺ homeostasis to help the host ameliorate salinity stress damage. Our findings indicate that the halophyte L. sinense can attract and recruit beneficial rhizosphere bacteria by REs under salt stress, and the recruited B. flexus KLBMP 4941 elicited PGP effects under salinity stress through complex plant physiological regulatory mechanisms. This study provides a foundation for the enhancement of the rhizosphere colonization ability of the PGP strain KLBMP 4941, which shows potential applications in phytoremediation of saline soils.

280-km experimental demonstration of a quantum digital signature with one decoy state

A quantum digital signature (QDS) guarantees the unforgeability, nonrepudiation, and transferability of signature messages with information-theoretic security, and hence has attracted much attention recently. However, most previous implementations of QDS showed relatively low signature rates and/or short transmission distance. In this Letter, we report a proof-of-principle phase-encoding QDS demonstration using only one decoy state. First, such a method avoids the modulation of the vacuum state, thus reducing experimental complexity and random number consumption. Moreover, incorporated with low-loss asymmetric Mach-Zehnder interferometers and a real-time polarization calibration technique, we have successfully achieved a higher signature rate, e.g., 0.98 bit/s at 103 km, and to date, a record-breaking, to the best of our knowledge, transmission distance of over 280-km installed fibers. Our work represents a significant step towards real-world applications of QDS.

[Room tilt illusion: a chief complaint need to be alert in otology clinic]

Objective:This study aims to investigated the clinical significance of room tilt illusion（RTI） in screening for central vertigo in otology clinic. Method:A retrospective study of 8 RTI cases out of 656 patients with dizziness and/or vertigo. The characteristics of the symptoms, signs, physical examination, and other examinations of RTI patients were analyzed. Result:①Patients with RTI complaints accounted for 1.2% of all patients with dizziness and/or vertigo in the same period. Of all 8 patients, 2 were with acute vestibular syndrome, 5 were with episodic vestibular syndrome, and one had no dizziness and/or vertigo attack. ②Two was diagnosed with acute cerebellar infarction, and 3 was diagnosed with posterior circulation transient ischemic attacks, 2 were diagnosed with definite vestibular migraine, and one was unable to identify the cause. ③All 8 patients had a sensation of environment tilting, which was episodic（single or repeated）, transient（seconds to minutes）, in the coronal plane, and with tilt angle 30-180°. ④Seven patients had dizziness and/or vertigo for minutes to hours after a transient RTI, and one patient had no other symptoms after RTI. ⑤All patients had no decrease in vHIT gain, 6 patients had abnormal oculomotor function, and one patient had mild horizontal semicircular canal paresis. Conclusion:Patients with RTI complaints mainly had central dizziness and vertigo diseases, and once are found in otology clinic, should be alert to the possibility of suffering from central diseases.

Experimental quantum key distribution with uncharacterized sources and projective measurements

In theory, quantum key distribution (QKD) can offer information-theoretic secure communication based on the laws of quantum mechanics. However, the vast majority of practical QKD implementations assume the perfect state preparation to ensure security, which is a demanding requirement with current technology. Here, by incorporating the mismatched-basis data, we report an experimental decoy-state QKD demonstration with uncharacterized encoding sources, which only requires that the encoding states are two-dimensional. Furthermore, the measurement operation of the receiver is loosened to be projective measurements. With a rigorous statistical fluctuation analysis, we can distribute secret keys when the transmission distances of the standard fiber link are 101 and 202 km. Our experimental demonstration represents a significant step toward realizing long-distance quantum communication, even with uncharacterized sources and projective measurements.

Fermentation conditions optimization, purification, and antioxidant activity of exopolysaccharides obtained from the plant growth-promoting endophytic actinobacterium Glutamicibacter halophytocola KLBMP 5180

In this study, an endophytic actinobacterium Glutamicibacter halophytocola KLBMP 5180, was investigated for the production and antioxidant activity of exopolysaccharides (EPSs). First, the suitable fermentation time, temperature, inoculation volume, pH value, and the carbon and nitrogen sources for EPSs production were obtained using the one variable at a time method (OVAT). Then, a central composition design was used for fermentation conditions optimization to obtain the maximum EPS yield. The optimal medium and condition were as follows: 100 mL broth in 250 mL Erlenmeyer flasks, including 3.65 g/L maltose, 9.88 g/L malt extract, 3.40 g/L yeast extract, 1.41 g/L MnCl₂, pH 7.5, culture temperature 28 °C, and 200 rpm for 7 days, which increased the yield of EPSs to 2.89 g/L. Two purified EPSs, 5180EPS-1 (MW 58.9 kDa) and 5180EPS-2 (10.5 kDa), comprising rhamnose, galacturonic acid, glucose, glucuronic acid, xylose, and arabinose, were obtained for chemical analysis and antioxidant evaluation. The scavenging ability and reducing power of the superoxide anion and hydroxyl radicals demonstrated the moderate in vitro antioxidant activities of the two EPSs, thus indicating their potential to be a new source of natural antioxidants. However, further structure elucidation and functional studies need to be continued.

[Concept and clinical application of surgical margin principle on head and neck cancers]

Surgical margin principle is one of the central surgical principles for head and neck cancers. Negative surgical margin is the primary purpose of surgery for head and neck cancers. This paper is based on the current clinical application of surgical margins of head and neck cancers, and it is proposed that surgical margins of head and neck cancers may be classified into three types: surface margin, deep margin, and tissue interface margin in consideration of surgical exposure of tumors. The classification of surgical margins can make the clinical application and the research of surgical margins of head and neck cancers more systematic and clear.

Screening and identification of biomarkers for systemic sclerosis via microarray technology

Systemic sclerosis (SSc) is a complex autoimmune disease. The pathogenesis of SSc is currently unclear, although like other rheumatic diseases its pathogenesis is complicated. However, the ongoing development of bioinformatics technology has enabled new approaches to research this disease using microarray technology to screen and identify differentially expressed genes (DEGs) in the skin of patients with SSc compared with individuals with healthy skin. Publicly available data were downloaded from the Gene Expression Omnibus (GEO) database and intra-group data repeatability tests were conducted using Pearson's correlation test and principal component analysis. DEGs were identified using an online tool, GEO2R. Functional annotation of DEGs was performed using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Finally, the construction and analysis of the protein-protein interaction (PPI) network and identification and analysis of hub genes was carried out. A total of 106 DEGs were detected by the screening of SSc and healthy skin samples. A total of 10 genes [interleukin-6, bone morphogenetic protein 4, calumenin (CALU), clusterin, cysteine rich angiogenic inducer 61, serine protease 23, secretogranin II, suppressor of cytokine signaling 3, Toll-like receptor 4 (TLR4), tenascin C] were identified as hub genes with degrees ≥10, and which could sensitively and specifically predict SSc based on receiver operator characteristic curve analysis. GO and KEGG analysis showed that variations in hub genes were mainly enriched in positive regulation of nitric oxide biosynthetic processes, negative regulation of apoptotic processes, extracellular regions, extracellular spaces, cytokine activity, chemo-attractant activity, and the phosphoinositide 3 kinase-protein kinase B signaling pathway. In summary, bioinformatics techniques proved useful for the screening and identification of biomarkers of disease. A total of 106 DEGs and 10 hub genes were linked to SSc, in particular the TLR4 and CALU genes.

[Prevalence and risk factors of aortic valve calcification among the elderly residents of Wuxi city, Jiangsu province]

Objective: To evaluate the prevalence and risk factors of aortic valve calcification among the elderly (≥65 years old) resident of Wuxi city, Jiangsu province. Methods: The household registration population aged ≥65 years old in Wuxi city was selected as the research subject by stratified sampling method from August 2017 to December 2018. Echocardiography was performed to assess the aortic valve calcification, and the participants were divided into calcification group and non-calcification group. Multivariate logistic regression analysis was used to explore the related risk factors of aortic valve calcification. Results: The age of the respondents was (73.6±7.1) years old, of which 48.8% (461 cases) were males.The prevalence rate of aortic valve calcification was 22.0% (208/944) in the elderly (≥ 65 years old) residents in Wuxi city. The prevalence rate in 65-69 years old, 70-74 years old, 75-79 years old, 80-84 years old and ≥85 years old was 16.7% (58/347),16.7% (41/245),16.2% (26/161),23.3% (24/103), and 67.0% (59/88),respectively. There were significant differences in age, weight, abdominal circumference, hip circumference, high-salt diets, exercise, hypertension, hyperlipidemia, diabetes, coronary heart disease, cerebrovascular disease, and carotid atherosclerosis between the non-calcified group (736 cases) and the calcified group (208 cases) (P<0.01 or 0.05).Multivariate logistic regression analysis showed that age (OR=1.077, 95%CI 1.053-1.101, P<0.001), diabetes mellitus (OR=1.697, 95%CI 1.174-2.453, P=0.005), and coronary heart disease (OR=1.964, 95%CI 1.378-2.799, P<0.001) were the risk factors of aortic valve calcification. Conclusions: The prevalence of aortic valve calcification in the elderly (≥65 years old) residents in Wuxi city of Jiangsu province increases with aging. Age, diabetes mellitus and coronary heart disease are the risk factors of aortic valve calcification in this population cohort.

[How to initially screen common central "malignant vertigo" at the bedside?]

Most of the common dizziness/vertigo diseases in otology clinic are peripheral vertigo diseases, and while about 20% -30% of all vertigo diseases are caused by central nervous system diseases. Pseudo vestibular neuritis, acute ischemic stroke with audiovestibular loss, and central paroxysmal positional vertigo are the three types of central "malignant vertigo" diseases which are most easily misdiagnosed by otologists. This article described the clinical characteristics and bedside physical performance of these three diseases, and summarized the differential diagnosis points for clinical reference.

The complete chloroplast genome sequence of the medicinal shrub Daphne Giraldii Nitsche. (Thymelaeaceae)

Daphne giraldii Nitsche. (Thymelaeaceae) is a slow-growing shrub which has been used in Chinese folk medicine and commonly called ‘Zu Shima’. In this study, we assembled the complete chloroplast (cp) genome of D. giraldii using data from high-throughput Illumina sequencing. The D. giraldii cp genome is 171,643 bp in size and includes two inverted repeat regions of 41,798 bp each, which is separated by a large single copy region of 85,171 bp and a small single copy region of 2876 bp. A total of 137 genes were predicted, including 38 tRNA, 8 rRNA, and 90 protein-coding genes. In addition, 10 PCG genes possess a single intron, 92 PCG genes no intron, 1 gene harbor two introns. Six tRNA genes harbor a single intron. Phylogenetic analysis indicated that D. giraldii is closer to Daphne kiusiana and Daphne tangutica than other taxa.

[Clinical characteristics of LC-BPPV patients with bilateral direction-fixed horizontal nystagmus in primary Roll test]

Objective:To investigate the clinical features of LC-BPPV with direction-fixed horizontal nystagmus in the primary Roll test. Method:Nine patients of LC-BPPV with bilateral direction-fixed horizontal nystagmus in the first Roll test were treated by repositioning maneuvers after judging the affected side and the prognosis was observed. Result:The affected side of eight patients was the side of the apogeotropic nystagmus. Barbecue or Gufoni maneuvers was effective for reposition. The other one had no conversion of nystagmus and could not judge the affected side. Conclusion:The nystagmus performance of patients with LC-BPPV is complicated. It is necessary to carefully analyze the nystagmus performance of each position. Combining with bow and lean test, lying down test and null plane, the position of the otolith is inferred. Comprehensive use of the Barbecue or Gufoni maneuvers, forced side lying on the affected side, mastoid sniper, shaking head method is effective to complete the reposition treatment.

Abnormal methylation of spermatozoa induced by benzo(a)pyrene in rats

Epigenetic mutations caused by pollutants are possibly linked to many diseases. Benzo(a)pyrene (BaP) is one of the most representative air pollutants and has aroused wide concern because of its strong carcinogenicity. The reproductive toxicity induced by BaP has been identified, but little is known about the characteristics of the methylation changes induced by BaP. In this study, a methylated DNA immunoprecipitation sequencing method was used to detect the methylation of sperm DNA of rats exposed to BaP. Compared with the respective genes in normal rats, there were 3227 hypomethylated genes and 828 hypermethylated genes after BaP exposure. Gene ontology enrichment analysis reported that differentially methylated genes (DMGs) were enriched in the localization, single-multicellular organism process and plasma membrane. Kyoto Encyclopedia of Genes and Genomes pathway analysis showed that the DMGs were significantly enriched in the Ras signalling pathway, Rap1 signalling pathway, pancreatic secretion and neuroactive ligand-receptor interaction. DisGeNET disease spectrum analysis showed that DMGs were associated with infertility and certain genetic diseases. Further research needs to be done to explore whether these abnormal methylation are transgenerational.

Twin-field quantum key distribution with modified coherent states

The twin-field quantum key distribution (TF-QKD) protocol is designed to beat the rate-distance limit of quantum key distributions without employing quantum repeaters; meanwhile, it can offer the measurement-device-independent secure level. In this Letter, we propose to improve the performance of TF-QKD protocols by employing modified coherent states. Based on the Wang et al. sending-or-not scheme [Phys. Rev. A98, 062323 (2018)PLRAAN1050-294710.1103/PhysRevA.98.062323], we study the key rate with the modified coherent states in finite data size and do comparisons with the one using weak coherent states. Through numerical simulations, we demonstrate that modified coherent states can substantially increase the performance of QKD more than the latter.

Practical quantum digital signature with a gigahertz BB84 quantum key distribution system: erratum

In this erratum the formulas (6) and (8) of Opt. Lett.44, 139 (2019) OPLEDP0146-959210.1364/OL.44.000139 have been updated.

Weak randomness impacts the security of reference-frame-independent quantum key distribution

Perfect randomness is of great significance in various quantum key distribution (QKD) protocols. In this Letter, we investigate the effect of weak randomness on the state preparation in reference-frame-independent QKD (RFI-QKD), which may be implemented with imperfect random numbers or quantum-state encoding devices. In the scenario of weak randomness, the maximal amount of information the eavesdropper can acquire should be carefully evaluated. With practical experimental parameters, we demonstrate that even a small proportion of weak randomness will impact the security of RFI-QKD seriously. Furthermore, we briefly study the side effect of weak randomness on RFI measurement-device-independent QKD (RFI-MDI-QKD), and simulation results show that weak randomness damages the performance of RFI-MDI-QKD more critically than that of RFI-QKD.

Diabetes-induced damage of gastric nitric oxide neurons mediated by P2X7R in diabetic mice

It is generally considered that enteric neuropathy is one of the causative factors in diabetic gastroparesis. Our previous study demonstrated that there is a loss of NOS neurons in diabetic mice. However, the underlying mechanism remains unclear. The present study was designed to clarify the relationship between neuronal P2X7R and NOS neuron damage. The effect of P2X7R on diabetes-induced gastric NOS neurons damage and its mechanism were investigated by using quantitative RT-PCR，immunofluorescence, western blot, isometric force recording, intracellular calcium ([Ca²⁺]i) measurement and whole-cell patch clamp techniques. The immunohistochemistry and western blot results showed that nNOS expression was significantly down-regulated in diabetic mice, meanwhile, electric field stimulation-induced NOS sensitive relaxation was significantly suppressed. Myenteric neurons expressed P2X7R and pannexin1, and the mRNA and protein level of P2X7R and pannexin1 were up-regulated in diabetic mice. BzATP, a P2X7R activator, evoked [Ca²⁺]i increase in Hek293 cells with heterologous expression of P2X7R (Hek293-P2X7R cells) and the same dose of ATP-induced [Ca²⁺]i was more obvious in Hek293-P2X7R cells than in Hek293 cells. Application of BzATP activated an inward current of Hek293-P2X7R in a dose dependent manner. Hek293-P2X7R but not untransfected Hek293 cells could take up of YO-PRO-1. In addition, the uptake of YO-PRO-1 by Hek293-P2X7R was blocked by oxATP, a P2X7 antagonist and CBX, a pannexin1 inhibitor. The results suggest that the P2X7R of enteric neurons may be involved in diabetes-induced NOS neuron damage via combining with pannexin-1 to form transmembrane pores which induce macromolecular substances and calcium into the cells.

Practical quantum digital signature with a gigahertz BB84 quantum key distribution system

Quantum digital signature (QDS) can guarantee message integrity and non-repudiation with information-theoretical security, and it has attracted more attention recently. Since proposed by Andersson et al. [Phys. Rev. A93, 032325 (2016)PLRAAN1050-294710.1103/PhysRevA.93.032325], a quantum digital signature protocol using an insecure channel has been realized with several different quantum key distribution (QKD) systems. Here we report an experimental QDS based on a BB84 QKD system. An asymmetric Faraday-Sagnac-Michelson interferometer structure has been designed in our system, which is intrinsically stable against channel disturbance. The innovatory structure supports the system to work at high speed and, in practice, the repetition rate is in gigahertz. A 0.044 bit/s signature rate has been attained with a 25 dB channel loss composed of a 25 km installed fiber with additional optical attenuation in a 10^-10 security level. Thus, our QDS device is stable and highly efficient. This Letter provides a further step for the practical application of QDS.

Effectiveness of the flipped classroom on the development of self-directed learning in nursing education: a meta-analysis

Objectives

To examine the best practice evidence of the effectiveness of the flipped classroom (FC) as a burgeoning teaching model on the development of self-directed learning in nursing education.

Data sources

The relevant randomized controlled trial (RCT) and non-RCT comparative studies were searched from multiple electronic databases including PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Wanfang Data, China National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Periodical Database (VIP) from inception to June 2017.

Review methods

The data were independently assessed and extracted for eligibility by two reviewers. The quality of included studies was assessed by another two reviewers using a standardized form and evaluated by using the Cochrane Collaboration’s risk of bias tool. The self-directed learning scores (continuous outcomes) were analyzed by using the 95% confidence intervals (CIs) with the standard deviation average (SMD) or weighted mean difference (WMD). The heterogeneity was assessed using Cochran’s I 2 statistic.

Results

A total of 12 studies, which encompassed 1440 nursing students (intervention group = 685, control group = 755), were eligible for inclusion in this review. Of 12 included studies, the quality level of one included study was A and of the others was B. The pooled effect size showed that compared with traditional teaching models, the FC could improve nursing students’ self-directed learning skill, as measured by the Self-Directed Learning Readiness Scale (SDLRS), Self-Directed Learning Readiness Scale for Nursing Education (SDLRSNE), Self-Regulated Learning Scale (SRL), Autonomous Learning Competencies scale (ALC), and Competencies of Autonomous Learning of Nursing Students (CALNS). Overall scores and subgroup analyses with the SRL were all in favor of the FC.

Conclusions

The result of this meta-analysis indicated that FCs could improve the effect of self-directed learning in nursing education. Future studies with more RCTs using the same measurement tools are needed to draw more authoritative conclusions.

[Multicenter investigation of extracorporeal membrane oxygenation application in pediatric intensive care unit in China]

Objective: To survey the conduction and evaluate the effectiveness of extracorporeal membrane oxygenation (ECMO) therapy in pediatric intensive care unit (PICU) in China mainland. Methods: In a questionnaire-based survey, we retrospectively reviewed the application of ECMO in children's hospital and general hospital in China mainland to summarize and analyze the categories of diseases and prognosis of children treated with ECMO therapy. Results: By December 31, 2017, a total of 23 hospitals using ECMO, including 22 tertiary referral hospitals and 1 secondary hospital, among which 16 were children's hospitals and 7 were general hospitals. Thirty-seven ECMO equipment was available. A total of 518 patients treated with ECMO, within whom 323 (62.4%) successfully weaned from ECMO and 262 (50.6%) survived to discharge. Among 375 pediatric patients, 233 (62.1%) were successfully weaned from ECMO and 186 (49.6%) survived to discharge. Among 143 newborn patients, 90 (62.9%) successfully weaned from ECMO, 76 (53.1%) survived to discharge. ECMO was applied in veno-arterial (VA) mode to 501 (96.7%) patients, veno-venous (VV) mode to 14 (2.7%) patients, and VV-VA conversion mode to 3 (0.6%) patients. Sixty-nine patients required extracorporeal cardiopulmonary resuscitation (ECPR), including 20 newborn patients (29.0%) and 38 pediatric patients (71.0%), who were all with cardiovascular disease. Neonatal respiratory distress syndrome (26/61), persistent pulmonary hypertension of the newborn (PPHN) (12/61), and meconium aspiration syndrome (MAS) (11/61) are the most common pulmonary diseases in newborn patients; among whom, infants with PPHN had highest survival rate (10/12), followed by MAS (9/11). Among newborn patients with cardiovascular diseases, those who admitted were after surgery for congenital cardiac disease were the most common (54/82), while those with septic shock had the highest survival rate (2/3). In pediatric pulmonary diseases, acute respiratory distress syndrome was the most common (42/93), while plastic bronchitis was with the highest survival rate (4/4), followed by viral pneumonia (13/16). Among pediatric cardiovascular diseases, congenital cardiac defect was the most common (124/282), while fulminant myocarditis had the highest survival rate (54/77). Conclusion: The application of ECMO as a rescue therapy for children with severe cardiopulmonary failure has dramatically developed in China mainland.